the formation of an academy." McDermott served in an ex officio capacity. 58

This group, with the unwieldy title of the Ad Hoc Panel on Further Institutional Forms for the Board on Medicine, met at the end of September 1968. The political climate lent a sense of urgency to the proceedings. When the Board started its work, the Democrats were in firm control of the White House and Congress. It now appeared as if Republican Richard Nixon might win the election and federal support for medical research and for social welfare programs, such as Medicaid, might weaken. As Adam Yarmolinsky told the Board, "Whoever is President of the United States—Humphrey, Nixon, Wallace, it is less likely that the kind of advice that we have to offer which involves spending money and doing things will be accepted."59

Whatever the urgency of the political situation, the Ad Hoc Panel moved at a very deliberate pace. A first meeting served only to set the stage for a second. "The discussions were quite tentative," Joseph Murtaugh reported to Fred Seitz, "with a great deal of uncertainty being reflected by the members in respect to many important points." 60 One of Page's allies wrote that he sensed a "foot-dragging attitude" on the part of McDermott. He urged Page to act independently of the National Academy of Sciences. He suggested that if nothing happened in the next few months, Page's original committee should be reactivated and a National Academy of Medicine should be organized on an independent basis.61 The head of the Dartmouth Medical School told Page that he was "bullheadedly holding to my original bias'' in favor of a National Academy of Medicine. ''The more I have thought about it ... the more I feel the academy is the only position to take," Page replied. He attributed opposition to the NAM to "public health people" and those "concerned with economics" who believed that "if medicine had the upper hand, we would all revert to our antediluvian days of which they are so highly critical."62

Walsh McDermott, whom Page would have classified as one of the public health people, refused to be stampeded. In a letter to London he tried to set the intellectual tone for the discussion. He began by pointing out that everyone agreed on the need for an institution, free of special interest, that included nonphysician professionals as well as physicians. The disagreement came over what purpose the institution should serve. The Page and Comroe faction favored an organization that spoke for medicine; McDermott wanted one that spoke about medicine. The first concept involved a group that addressed problems within medicine and expressed the medical viewpoint. The second concept addressed the need for an entity that "would speak to the

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